Background: Nodular thyroid lesions are common among the population, especially women. Four-step processes were needed to evaluate thyroid nodules; starting with a history and clinical examination, followed by thyroid function test, then thyroid ultrasound (US) examination, and lastly US-guided aspiration cytology. The availability of thyroid imaging reporting and data systems (TIRADs) allows for an accurate clinic-pathological correlation. Moreover, the Bethesda system for reporting thyroid cytopathology was introduced to standardize the communication of fine-needle aspiration cytology (FNAC) interpretation between pathologists and clinicians. Aim: We aimed to assess the diagnostic utility of TIRAD and the Bethesda systems, separately and in combination, to explore the accuracy of the combination of these two standardized grading methods in the differential diagnosis of thyroid nodules. Materials & Methods: This is a retrospective study including patients with thyroid nodules. Clinical data of the patients were collected from their reports. TIRADs system was used to classify solitary thyroid lesions. All FNAC and cell block slides were revised. The Bethesda system was used to classify the thyroid lesions. All radiological and pathological results were correlated statistically. Results: By combining sensitivity and specificity of both TIRADs and Bethesda systems, sensitivity for detecting the nature of thyroid nodule was raised to 90.8% and the specificity was increased to 98%. Conclusion: Combination of both Bethesda systems and TIRADs increases the accuracy of evaluation of thyroid nodules to take the appropriate surgical decision.